GELFAND’S WORLD-Cassandra Fortin (photo) is being held against her will by the government of Connecticut and being forced to endure painful chemical infusions. What's worse, she is only 17 years old. That's the argumentative way of describing a situation in which a teenager with a curable cancer is trying to refuse the one treatment that is likely to save her. She has Hodgkin's Lymphoma, a once generally fatal disease that can now be cured in the large majority of cases. Chemotherapy would give Cassandra about an 80% likelihood of surviving and living a normal life.

I think Cassandra is being unwise to try to refuse treatment, but chemotherapy has side effects, some unpleasant, and the deep question is whether someone who is technically a minor, but in reality pretty close to adult status, should have the right to decide for herself whether to refuse treatment.

Another question, to put it more bluntly, is whether this 17 year old is as mature as she needs to be. What little I can gather from news reports is that she treats chemotherapeutic drugs as "poison," which is both true and largely irrelevant. It's irrelevant because when you have lymphoma, you need the right kind of poison (one that goes after cancer cells) if you want to survive. She has made it known to the world that she doesn't wish to have poison put into her body. Penicillin can have side effects too, but it is the right kind of poison to put into your body if you have bacterial pneumonia. You might have a severe allergic reaction to penicillin, and you may react badly to cancer chemotherapy, but each is the right kind of poison for a particular kind of ailment.

Complicating the question, at least in the minds of the doctors and the court, is that Cassandra appears to be much under the influence of her mother, and they view that influence as malign. In short, the mother supports her daughter's right to choose for herself. Whether the mother subscribes to some of the currently fashionable unscientific views that oppose modern medical care remains to be seen, but when people talk about replacing medical treatments that have been shown to be effective with "natural" treatment, my antennae begin to vibrate. There are lots of natural remedies for naturally occurring cancers, and for the most part they are useless. It took humankind lots of centuries until we could diagnose lymphomas accurately and treat some of them effectively.

Mom and Cassandra (photo) may have human rights on their side, but we have to recognize that they are, in essence, asserting the right to be blockheaded, and stubborn to the point of suicide.

The law, at least our law, gives us the right to be blockheaded and stubborn, at least as long as we are 18 years old, and we are exercising the choice as to whether or not to accept medical treatment. That legal argument doesn't seem to be in doubt, with very few exceptions.

The legal fight seems to be defined pretty much along those lines. Cassandra's attorneys will argue that she may not be quite 18, but 17 should be old enough to decide whether you consent to puke your guts out in the hopes of living a little longer.

The government of Connecticut and the doctors who helped provoke the current controversy are relying on a well established scientific consensus that this disease is fatal when left untreated, but highly curable when treated promptly and according to the procedures that have been so carefully developed over the years. It's a highly persuasive position, because it is backed up by a lot of technically deep, carefully measured outcomes for different approaches to treatment. To be even blunter, a lot of kids had to die in order for medical science to get to the point that it can confidently suggest that you have a better than four in five chance of survival if you can put up with the chemistry.

The counterargument, that because chemotherapy is bad, there must be something better, is unconvincing. You have to be either ignorant or working hard on denial to believe in that position. And this seems to be where Cassandra is going at the moment.

You have to sympathize not only with Cassandra, but with the medical establishment, because there is no easy answer. Chemotherapy is hard on people, but letting cancer go its own way is generally worse. It would be nice if there were a largely painless, effective treatment, or better yet, prevention, for the disease that bedevils Cassandra Fortin.

This leads to a related discussion which strangely enough includes Disneyland.

There are vaccine preventable diseases, which fit all those criteria of having a nearly painless and effective prevention, and yet are refused for obtuse reasons by blockheaded parents. Only in this case, it is not a prolonged, painful course of treatment. It's what the English call "the jab," and we Americans call "a shot." The news this week included a measles outbreak in California and Utah. It's not large, roughly about a dozen cases so far, but the fact that the disease was spread at Disneyland caught the attention of the news media.

California, and particularly Orange County, has become a center of vaccine denial. Measles, mumps, and rubella are covered by one vaccine known as the MMR (for obvious reasons), and a lot of parents avoid letting their toddlers have it. Some of this seems to be based on the long-since-refuted mythology that vaccines cause autism. The problem is that measles kills about one in five-hundred of its victims, and causes many to get sick enough to require hospitalization. When one of the known side effects is brain damage, you ought to take it seriously. When another side effect is a delayed syndrome that progressively destroys the brain and ultimately results in death, you ought to take it even more seriously.

The other thing about measles is that it is incredibly infectious. If you lack immunity, you can get measles just by entering a room that an infectious person walked through earlier. Now consider being at a giant theme park where there are another twenty-five thousand people, and one of them has an early case of the measles. If you didn't ever get that MMR shot, you may find yourself with a high fever, an itchy rash, and the danger of brain disease.

Luckily, most school aged children get immunized, but there are exceptions. There is an interactive online map we have mentioned here before, where you can check the immunization status of the local schools. Most of our public schools are fairly well covered, but there is the odd school here and there where the immunization level falls well below the recommended level of at least 92-95% of the incoming students having had their shots. When you look at the map for the harbor area, for example, many kindergartens are well protected, but there are also several that pop up on the map in red or orange, showing that immunization levels are dangerously low.

If you look at the prosperous west side, you see even more. Somehow getting that bachelor's degree in Business or English doesn't necessarily confer deep medical judgment, in spite of literacy and the ability to do searches on Google. There is just too much wrong information being put out by snake oil peddlers on the internet. Parents: It's not the same as four years of medical school, or an advanced course in immunology. Besides measles, whooping cough (pertussis) is a horrible but preventable illness, and we have been having our own California epidemic of pertussis.